Provider Demographics
NPI:1497235279
Name:RADKIEWICZ, KRISTYN MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTYN
Middle Name:MARIE
Last Name:RADKIEWICZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WATER ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-2148
Mailing Address - Country:US
Mailing Address - Phone:574-540-2052
Mailing Address - Fax:574-540-2540
Practice Address - Street 1:105 WATER ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-2148
Practice Address - Country:US
Practice Address - Phone:574-540-2052
Practice Address - Fax:574-540-2540
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008485A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily